Paediatrics Emergency Medicine Strong — Lancet 2009

PECARN Paediatric Head Injury

Decision rule for CT head in children with head injury. Minimises radiation exposure. Two algorithms: < 2 years and ≥ 2 years.

Used in: Head Injury

Age group*

GCS score*

Other signs of altered mental status (agitation, somnolence, repetitive questioning, slow response to verbal communication)*

Palpable or unclear skull fracture (< 2 years) / signs of basilar skull fracture (≥ 2 years)*

Haemotympanum, Battle's sign, raccoon eyes, otorrhoea, rhinorrhoea

Under 2: occipital, parietal or temporal scalp haematoma

Yes

Loss of consciousness — under 2: 5 seconds or more; 2 and over: any

Yes

Under 2: not acting normally per parent

Yes

2 and over: history of vomiting

Yes

2 and over: severe headache

Yes

Severe mechanism of injury

MVC with ejection, death of another passenger or rollover; pedestrian or unhelmeted cyclist struck by a motorised vehicle; fall > 0.9 m (under 2) or > 1.5 m (2 and over); head struck by a high-impact object

Yes

Score interpretation

Very Low Risk — CT Not Recommended 0

No PECARN predictor. Validation NPV for clinically important TBI: 1176/1176 under 2; 3798/3800 aged 2 and over.

→ Discharge with head injury advice; return if worsening headache, persistent vomiting, unusual drowsiness, seizure or behaviour change.

Intermediate Risk — Observation or CT 1

Only intermediate-risk predictors present.

→ Observation or CT by clinician experience, multiple versus isolated findings, worsening signs, age under 3 months and parental preference.

High Risk — CT Recommended 2

GCS < 15, altered mental status or skull fracture signs.

→ CT head. Neurosurgery on standby if significant intracranial injury is found.

Interpretation bands for the PECARN. Apply clinical judgement and local guidance.

References

Kuppermann N et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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